DIAGNOSIS:
Diagnosis of acute pain is
easy and clear because a particular body part
has gone wrong manifest. However, the
diagnosis of chronic pain and TMJ disorders are
difficult because there is often a disconnection between
the source of the pain and the pain experience. It
is difficult to assess pain objectively, to adjust to
the condition, and often times the
best measure of chronic pain intensity is the patient's
word.
If you have an incorrect diagnosis and treat it accordingly, your pain and
dysfunctions will not go away. Further, you very
well may end up traveling
from office to office in an attempt to find out causative
factors and relieve the pain. The following is a typical
example:
I am a 45 year old female. I found your website
while I was searching on google for some diagnosis
for all my problems. I know I have TMJ as my jaw has
been popping and clicking for as long as I can
remember. I have been having headaches, neck pain,
shoulder pain, arm pain, tingling in my arms and
hands, teeth pain, etc. off and on for years. Every
couple of years my neck will 'go out' and I will go
to a chiropractor for a few weeks. I started going
to a chiropractor last October for neck pain and
headaches. This time I got worse instead of getting
better. I started getting severe headaches, severe
tingling in my arms and hands and twitching in my
right hand. I was referred to an orthopaedic doctor. I have had several MRI's (brain, neck
and lumbar). I have pinched nerves and bulging discs
in my neck. I was referred to a neurologist because
my doctor wanted to rule out MS. After testing by
the neurologist, it was determined I didn't have MS
and was turned back over to my orthopaedic doctor. He sent me to a pain specialist to get a steroid
shot in my neck hoping it would relieve my headaches
enough so I could go through physical therapy for my
neck. We waited two weeks after the injection to see
if it was going to help with my headaches. I did get
some relief. Some days I didn't have a headache at
all (which for me is extremely rare.) I started
physical therapy about 3 weeks ago. After the third
session, I woke up the following day with the worst
headache of my life that lasted for almost two days. I called my doctor and he discontinued physical
therapy and decided it is time for me to go to an orthopaedic surgeon for another opinion. I have an
appointment to see the surgeon tomorrow. And I have
another appointment for another injection in another
part of my neck. I told my doctor that I am ready
for surgery if it will help ease my pain. I don't
know how much more I can deal with. As I sit here
typing this email, I have a fairly severe headache
(I woke up with it this morning), my arms are
tingling and my shoulders and neck hurt. Please send
me any information you can.
Sincerely,
Finding out the true source of
pain is critically important and is the key factor
for the treatment. Such, multiple diagnostic
procedures
are developed:
medical-dental history, clinical examination, dental examination (intra-oral and
extra-oral),
occlusion analysis, jaw and neck range of motion,
cranial nerve screening, skeletal morphology and posture
evaluation, muscle
palpation,
bio-mechanical functional test,
TM joint x-ray and required imaging, electro-diagnostics (jaw joint vibration analysis, jaw tracking
analysis), listening to the jaw joint sound, diagnostic
splint, orthopedic jaw casts, diagnostic photograph, TMJ scale, diagnostic anesthetic block,
etc.
Because the majority of chronic
pain and TMJ disorder symptoms are pain (location,
severity, frequency, duration) and dysfunction
(inability for certain body movements), even all these
modern diagnostic procedures and MRI observation do
not necessarily provide doctors an accurate diagnostic
information or
clear treatment protocol. Objective
clinical assessment and evaluation of the
relationship between pain/dysfunction and TMJ is very important.
If
the patient responds
positively during assessment and evaluation session, it enables
practitioners to create and implement a treatment protocol with confidence,
and except successful
treatment outcome.
Dr. Kim uniquely
developed a simple on-site assessment and diagnostic
program, which enables him to identify the true source
of pain and dysfunction objectively, whether the
symptoms are related with TMJ, and whether
the symptoms can be improved with treatment or not.
TREATMENT:
The goal of the
treatment is to relieve pain, improve function, and
maintain a pain free
condition. Acute pain
treatment is to find the source and provide pain relief.
Generally, chronic pain treatment is poor in medical
outcomes, the definitive treatment
procedure is not clear, and multiple treatment modalities
are
utilized case by case: various medications,
around-the-clock analgesia, time release-opioid, trigger point injection, nerve ganglion
block injection, botox
injection, physical therapy, prolotherapy, T.E.N.S.,
infrared therapy, laser therapy, iontophoresis,
stretch and spray, acupuncture,
acupressure, neuromuscular massage, biofeedback,
craniosacral
therapy, chiropractic
manipulation,
nutritional evaluation, various intraoral orthotic
(splint),
functional jaw orthopedic appliance, NTI-tss, anterior
repositioning appliance, orthodontic teeth and jaw correction,
and comprehensive dental
work, etc.
There are also some recommended
"self-care" treatment options: resting the jaw,
relaxing the jaw muscles, doing jaw exercises, keeping the teeth apart and refraining
it from clenching, keeping the head
neck and back up-straight to maintain a good jaw
posture; eating soft food, applying ice and heat,
exercising the jaw
in order to
restore a normal range of movement etc. Often times,
even after attempting all these treatment procedures, you may end up with
disappointment. Some
estimates as high as 90% of individuals with baseline
pain, state that pain control is unstable, and continue to
experience "break through" pain.
This
warrants reassessment of the cause and approach for
management of chronic pain, requires stronger or
additional pain medications, which may cause various
side effect and create new problems, and attempts to
utilize non-pharmacologic multidisciplinary modalities.
Thus, the goal then becomes a management instead
of treatment, which would allow the patient to go
to work, walk around, clean the house, do outdoor
activity, etc. It is necessary to develop a
greater sophistication and efficiency in the assessment,
diagnosis, definitive treatment and management of pain
and dysfunction.
At TMJ Head &
Neck Pain Center, based on thousands
of hours of
continuing education, hands-on courses, extended
knowledge and clinical experience in general dentistry,
basic medicine, toxicology, neuromuscular dentistry,
orthodontics, holistic
dentistry, dental sleep medicine, nutritional
supplements, allopathic medicine, and oriental medicine, Dr. Kim developed
a comprehensive but simple assessment and treatment
protocol, which he utilizes over 95% of the time with
great success and patient satisfaction.
The Resultant Force Vector Technique is the key for
a successful treatment outcome. This technique
is so powerful and effective that over 90% of the time,
headaches, neck pain, back pain & other chronic symptoms
improve immediately or in a short period of time after
treatment begins without medication or
painful procedures. Dr. Kim was
fortunate enough to learn this exceptional technique and
is proud of giving a "new life" to patients who
have been suffering from intractable pain and
dysfunction for many years.
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